Behandlungsspektrum von Lymphomen und Plasmozytomen der Wirbelsäule

Zusammenfassung

Diese Übersichtsarbeit beschäftigt sich mit dem Behandlungsspektrum von Lymphomen und Plasmozytomen der Wirbelsäule, insbesondere hinsichtlich der operativen Versorgung bei akuter neurologischer Beeinträchtigung sowie instabilitätsgefährdenden Frakturen mit dem Risiko der weiteren funktionellen Verschlechterung. Die Manifestation eines malignen Lymphoms an der Wirbelsäule ist vergleichsweise selten; in der Literatur sind nur wenige Fälle und Fallserien beschrieben. Daher gibt es keinen Goldstandard für die Behandlung von Patienten mit Lymphom-Manifestationen an der Wirbelsäule. Ebenso verhält es sich bei Plasmazellneoplasien; diese lassen sich in Subtypen unterteilen, darunter das multiple Myelom (MM) und das solitäre Plasmozytom des Knochens (SBP). Die ersten klinischen Anzeichen sind Skelettschmerzen, die meist Rippen und Wirbel betreffen. Bei osteolytischen Knochenläsionen ist die Wirbelsäule bei 60–80 % der MM-Patienten betroffen, hier mit fortschreitender Osteolyse, so dass eine Stabilität der Wirbelsäule nicht gewährleistet ist.

Abstract

This review addresses the treatment modalities of spinal manifestations of malignant primary and secondary bone lymphomas as well as of Spinal lesions as clinical manifestations of plasma cell neoplasia, particularly with regard to surgical management in case of acute neurologic impairment as well as fractures threatening instability with the risk of further functional deterioration. The manifestation of malignant lymphoma in the spine is rare; only a few cases and case series have been described in the literature. Therefore, there is still no gold standard for the treatment of patients with spinal lymphoma manifestations. The same is true for plasma cell neoplasms; these can be divided into subtypes, including multiple myeloma (MM) and solitary plasmacytoma of bone (SBP). The first clinical signs are skeletal pain, usually affecting ribs and vertebrae. In osteolytic bone lesions, the spine is affected in 60–80% of MM patients, here with progressive osteolysis, so that spinal stability is not guaranteed.

Schlüsselwörter

Lymphom - Plasmazellneoplasie - multiples Myelom - solitäres Plasmozytom des Knochen - Wirbelsäule

Keywords

lymphoma - plasma cell neoplasia - multiple myeloma - solitary plasmacytoma of bone - spine

Publikationsverlauf

Artikel online veröffentlicht:
14. November 2022

• Literatur

• 1 Messina C, Christie D, Zucca E. et al. Primary and secondary bone lymphomas. Cancer Treat Rev 2015; 41: 235-46
• 2 Alencar A, Pitcher D, Byrne G. et al. Primary bone lymphoma--the University of Miami experience. Leuk Lymphoma 2010; 51: 39-49
• 3 Han S, Yang X, Jiang D. et al. Surgical Outcomes and Prognostic Factors in Patients With Diffuse Large B-cell Lymphoma-associated Metastatic Spinal Cord Compression. Spine (Phila Pa 1976) 2016; 41: E943-e8
• 4 Laufer I, Rubin DG, Lis E. et al. The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist 2013; 18: 744-51
• 5 Kazandjian D. Multiple myeloma epidemiology and survival: A unique malignancy. Semin Oncol 2016; 43: 676-81
• 6 Wang Y, Li H, Liu C. et al. Solitary Plasmacytoma of Bone of the Spine: Results From Surveillance, Epidemiology, and End Results (SEER) Registry. Spine (Phila Pa 1976) 2019; 44: E117-e25
• 7 Rajkumar SV, Dimopoulos MA, Palumbo A. et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014; 15: e538-48
• 8 Langseth ØO, Myklebust T, Johannesen TB. et al. Incidence and survival of multiple myeloma: a population-based study of 10 524 patients diagnosed 1982–2017. Br J Haematol 2020; 191: 418-25
• 9 Durie BGM, Hoering A, Abidi MH. et al. Bortezomib with lenalidomide and dexamethasone versus lenalidomide and dexamethasone alone in patients with newly diagnosed myeloma without intent for immediate autologous stem-cell transplant (SWOG S0777): a randomised, open-label, phase 3 trial. Lancet 2017; 389: 519-27
• 10 Abbott KC, Agodoa LY. Multiple myeloma and light chain-associated nephropathy at end-stage renal disease in the United States: patient characteristics and survival. Clin Nephrol 2001; 56: 207-10
• 11 Cai W, Yan W, Huang Q. et al. Surgery for plasma cell neoplasia patients with spinal instability or neurological impairment caused by spinal lesions as the first clinical manifestation. Eur Spine J 2015; 24: 1761-7
• 12 Kaloostian PE, Yurter A, Zadnik PL. et al. Current paradigms for metastatic spinal disease: an evidence-based review. Ann Surg Oncol 2014; 21: 248-62
• 13 Barz M, Aftahy K, Janssen I. et al. Spinal Manifestation of Malignant Primary (PLB) and Secondary Bone Lymphoma (SLB). Curr Oncol 2021; 28: 3891-9
• 14 Hashi S, Goodwin CR, Ahmed AK. et al. Management of extranodal lymphoma of the spine: a study of 30 patients. CNS Oncol 2018; 7: Cns11
• 15 Kyriakou C, Molloy S, Vrionis F. et al. The role of cement augmentation with percutaneous vertebroplasty and balloon kyphoplasty for the treatment of vertebral compression fractures in multiple myeloma: a consensus statement from the International Myeloma Working Group (IMWG). Blood Cancer J 2019; 9: 27
• 16 Wagner A, Haag E, Joerger AK. et al. Comprehensive surgical treatment strategy for spinal metastases. Sci Rep 2021; 11: 7988
• 17 Soutar R, Lucraft H, Jackson G. et al. Guidelines on the diagnosis and management of solitary plasmacytoma of bone and solitary extramedullary plasmacytoma. Clin Oncol (R Coll Radiol) 2004; 16: 405-13
• 18 Attal M, Lauwers-Cances V, Hulin C. et al. Lenalidomide, Bortezomib, and Dexamethasone with Transplantation for Myeloma. N Engl J Med 2017; 376: 1311-20
• 19 Singhal S, Mehta J, Desikan R. et al. Antitumor activity of thalidomide in refractory multiple myeloma. N Engl J Med 1999; 341: 1565-71
• 20 Cavo M, Zamagni E, Tosi P. et al. Superiority of thalidomide and dexamethasone over vincristine-doxorubicindexamethasone (VAD) as primary therapy in preparation for autologous transplantation for multiple myeloma. Blood 2005; 106: 35-9